Senior Pharmacist - Strategy

Highmark Health; Pennsylvania; Hybrid; USD 140,000 - 180,000; Full time

Job summary

Highmark Inc. seeks a pharmacist to operate in a hybrid role near the corporate office, guiding formulary development and utilization management programs, monitoring FDA approvals and drug pipelines, and crafting policy-driven initiatives for better outcomes.

The role emphasizes collaboration with matrix partners, education for physicians and members, and ensuring strict adherence to regulatory standards, with mentorship to junior staff and engagement across committees.

Qualifications

• 5 years of related, progressive experience in the pharmacy area or completion of an accredited PGY-1 Managed Care Pharmacy Residency Program plus 2 additional years of related, progressive experience
• Preferred experience in pharmacy strategy, formulary administration, or product development within a health system, health plan, or PBM

Responsibilities

• Lead formulary and utilization management program initiatives to support savings goals
• Ensure regulatory compliance with state and federal requirements for the prescription drug benefit
• Collaborate with analytics teams and external vendors to generate real‑world evidence for strategy
• Provide guidance and mentorship to junior team members

Skills

Managed care pharmacy principles

Verbal & written communication

Data processing

Problem identification & solving

Team collaboration

Education

Bachelor of Science in Pharmacy or Doctor of Pharmacy

Tools

Microsoft Office

Database applications

Job description

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This role operates in a hybrid model (T,W,TH) for employees residing within 50 miles of the corporate office.

This job works in a team-oriented environment monitoring FDA-approvals, drug manufacturer pipelines, and assessing drug utilization reports, to develop and execute the the organization's drug formulary, and develop pharmacy utilization management policies, and maintains compliance with federal, state, and other mandates. The incumbent may write drug monographs for committee review; develop and implement the organization's management programs including but not limited to: prior authorization, dose and duration edits, quantity limits, step-care edits, generic sampling, pharmacy policy review and development and/or review of member specific information to improve individual outcomes. The incumbent develops and implements physician, pharmacy, account, and member educational initiatives that promote the organization's formularies, utilization management programs, and participates on cross-functional committees to develop and implement clinical and operational initiatives, working in close collaboration with matrix partners and stakeholders across the organization. The incumbent may interact with pharmaceutical manufacturers, the pharmacy benefit manager, and/or strategic partners to implement clinical formulary and utilization management strategies. The incumbent may provide guidance to more junior team members, participate in evaluating, implementing, and monitoring pharmacy benefit-focused federal and state legislation, develop, execute, and monitor pharmacy-specific strategic initiatives, and/or present recommendations to leadership.

ESSENTIAL RESPONSIBILITIES

• Formulary & Utilization Management Strategy & Development: May lead Highmark's evidence-based medicine drug evaluation program supporting Highmark's formulary and utilization management (UM) and/or pharmacy program strategy. Develop pharmacy formulary and UM program initiatives supporting Highmark Enterprise Customer Value Creation (C2V) program savings goals. Assist in the development of drug formularies by monitoring FDA-approvals and drug manufacturer pipelines, assessing drug utilization reports, and writing drug monographs for Pharmacy & Therapeutics Committee review, as applicable. Assist in the development and implementation of utilization management programs including but not limited to: prior authorization, dose and duration edits, quantity limits, step therapy edits, generic sampling, pharmacy policy review and development and/or review of member specific information to improve individual outcomes.
• Regulatory Compliance & Oversight: Execute Highmark's Pharmacy & Therapeutics Committee charter and program compliance in accordance with regulatory standards. Support regulatory compliance related to the organization's prescription drug benefit, formularies, and pharmacy utilization management policies. Manage formulary administration and oversight, ensuring all aspects of work adhere to applicable state and federal requirements. May represent Highmark in applicable state or federal audits.
• Strategic Collaboration & Analytics: May partner with internal analytics organization and external pharmacy vendors (as applicable) to generate real-world evidence insights to support of Highmark pharmacy strategy. Participate in cross-functional committees to develop and implement clinical and operational initiatives within the organization with focus on pharmacy.
• Quality Assurance & Review: Serve as a peer-reviewer of medication reviews, pharmacy utilization management policies, and other strategy deliverables, as applicable.
• Education & Communication: Develop and implement physician, pharmacy, client, and member educational initiatives that promote the organization's pharmacy strategies including formularies, utilization management programs, and other pharmacy programs.
• Project Management & Process Improvement: Identify and assist in managing department process improvements to maximize overall efficiencies. Manage individual projects for timely review with leadership.
• Team Guidance & Mentorship: Provide guidance to more junior team members.
• Other duties as assigned or requested.

EXPERIENCE

Required

• 5 years of related, progressive experience in the pharmacy area of specialization OR completion of an accredited PGY-1 Managed Care Pharmacy Residency Program plus 2 additional years of related, progressive experience in the pharmacy area of specialization

Preferred

• Progressive experience in pharmacy strategy, formulary administration, pharmacy program or product development within a health system, health plan, or pharmacy benefit manager setting

SKILLS

• An understanding of managed care pharmacy principles and practices is essential
• Demonstration of strong verbal and written communication skills, as well as proficiency in the use of computer-based data processing
• Microsoft Office products, and database applications
• Be able to quickly identify and prioritize essential elements of problem
• Independently or in a team, be able to identify the root issues and formulate potential solutions

EDUCATION

Required

• Bachelor of Science in Pharmacy or a Doctor of Pharmacy degree

Preferred

• None

LICENSES or CERTIFICATIONS

Required

• Registered Pharmacist (Non-State Specific)

Preferred

• Board Certified Pharmacotherapy Specialist
• Board Certified Geriatric Pharmacist

Language (Other than English):

• None

Travel Required: